Rep Pramila Jayapal's Medicare For All Act fixes America's dire and broken health-care system; take action to support it now!

I had no insurance, ACA passed and then the law said I had to have insurance. What did i miss?

I negotiate prices and shop arround just like with all major expenses in my life.

I can’t tell if you are trying to be funny or can’t do math. By law, the private health insurance industry must spend a minimum of 85% providing healthcare. Administration and profit are from the remaining 15%. Assuming that people are going to still need the healthcare than the 85% pays for and that none of the administration is needed means a maximum cut of 7.5% (not 50%) right off the bat.

Since insurance companies are averaging 3.1% profit, then the cut right off the bat could be as low as 1.6%.

No, it takes more than “just have the government pay for healthcare” to reduce costs.

Here’s why I roll my eyes at all the “we mustn’t do anything unless the plan is 100% perfect in every way” concern trollery:

But isn’t my damn job. Every other comparable country in the world manages to deliver superior health care at a far lower cost. That part is off the shelf. The transition is the hard part, but it doesn’t have to be hard for “me.” It doesn’t have to be expensive for “me.” Other people can take care of that shit. That’s what the wonks should work on, not how to make me have more skin in a game which already involves my literal skin.

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That’s their premiums revenue, not even counting copays, coinsurance, or the expenses they don’t cover.

ETA: Dammit, and having to argue this again and again makes me numb to some of the salient points. FFS, the $3.5T is SPENT by PEOPLE ALREADY. You’re playing 3-card Monty with health care expenditures. Everyone in the chain, from insurers to doctors to hospitals are getting paid, and many are for-profit. Even if there is ZERO improvement in efficiency, the money is already there. It’s already spent. What do you mean, how are we going to pay for it? We already do!

And that’s a big part of why healthcare is so expensive in the US. If you can only profit off of 15%, make the 85% as big as possible to grow the 15%. Perverse incentives lead to market distortion, film at 11.

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To put this meme in its proper context, and not what the right-wing echo chamber’s corporate taint-lickers have twisted it into:

Pelosi was responding to the absurd criticisms of the ACA that had absolutely zero basis in reality when she said that once the bill was passed, people would have the ability to see what was actually in it, as opposed to the “pull the plug on grandma”, “gubmint’s gonna take away your Medicare” fearmongering that Republicans had spent the previous 2 years fomenting. She knew exactly what was in it. So did Republicans. There was no secret hidden agenda that would only be revealed once the bill was passed; only the truth.

I forget if I posted this math in a previous thread, or if I’ve only ranted about it on Twitter, but here we go (with improved math either way, because I finally found the actual rate sheets):

Last year, I paid $4,820 for medical insurance. That’s 100% of my wife’s premium, plus 25% of my own. My employer covers the remaining 75% of my premium. All told, that’s roughly $6,250 for two people. Vision and dental insurance are about another $900. That doesn’t include the costs of medications, doctor’s visits, blood tests, or medical equipment (my CPAP costs about $800 per year to keep supplied), all of which comes out of pocket because of a better-than-most-plans-of-an-equivalent-cost $2,000 deductible.

Over the same period, I had just over $2,000 taken out of my paychecks for federal taxes (and with my tax return factored in, the total amount of federal taxes I paid was about $1,350). You would have to literally quadruple – if not quintuple – my federal taxes in order for a single-payer public insurance program to cost me the same as what I’m paying for private insurance (plus out of pocket expenses!) right now.

If you want to talk costs, I’m going to be paying for last year’s CPAP supplies until August of this year. Next month I’ll be paying off a 15 minute kidney ultrasound I got two years ago because it cost me almost $1,000. Back in 2010 I was charged over $300 for the privilege of having a camera shoved into my bladder so that I could be told that I’d probably passed a kidney stone (on top of the several hundred dollars in urgent care and emergency room bills I incurred because it turns out urine shouldn’t look like Hawaiian Punch).

Of course it’s not free. Only an idiot would think that an entire country’s health care infrastructure was being run without anyone paying a dime for it. (Well, there are morons like Rand Paul who equate Medicare for All with slavery, but I digress…) What it is is free at point of service. Just like public primary and secondary education in the US. There isn’t someone standing outside the school building asking for your $60 co-pay before they let your kid into class. And as I’ve pointed out, a public single-payer system would need to be stupefyingly inefficient – like, somehow even more inefficient than our existing dumpster fire of a system – in order for it to cost more than what we’re collectively paying right now. Even right-wing think tanks agree.

And if the right wing, which has never met a non-defense-related government program they thought could be done better and cheaper by the public sector, thinks the savings are $2 trillion over 10 years, it’s probably a good bet the actual savings would be even more substantial.

Good luck with that if you ever find yourself hit by a car and transported unconscious by an ambulance you didn’t choose to a hospital that you didn’t select where you receive a bunch of care from people you didn’t shop around for. Affordable health care should not depend on a person’s ability to haggle like they’re buying a fucking car.

In the meantime, can I borrow your galaxy brain to explain to my insurer why my in-network primary care physician no longer counts as a primary care physician despite being treated as one for the last 4 years? Because neither I nor my doctor’s office nor the provider’s billing department seem to be capable of doing so. This has been going on for 6 months now, and I have neither the time nor the energy to chase people down and sit through endless phone trees and figure out who needs to get these cryptic codes that get written down on post-it notes for me with no explanation. So I’m stuck with paying another $20 for my doctor’s visits.

I did my shopping around, and I’m still getting fucked. The entire system is garbage, and it needs to be destroyed root and branch.

For the sake of comparison, if insurance companies are averaging 3.1% profit and the rest of the allowable 15% in non-care spending is administration, that means their administrative overhead is about 12%. Meanwhile, Medicare’s administrative overhead is 1.4%.

How’s that for some savings?

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And the mandate has since been repealed, it was in face one of the first parts of the ACA that they went after.

I hope you or anyone in your family never faces a serious illness, because unless you’re VERY rich, you’re really going to be fucked. No one deserve that.

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You two socialist freedom-haters are not making allowances for Rugged Individualist tycoons who are masters of negotiation.* Such superior beings, who can haggle in their sleep (or unconscious and bleeding in this scenario) don’t need insurers of any sort to cover health care for themselves or their children.

[bracing myself for a discussion about how country doctors were paid by their patients with chickens or bushels of onions in “the good old days”]

[* it’s far from clear if the person you’re responding to is one of them. This is an observation about a general type.]

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It seems to me that any practice that only takes the simplest of cases is not going to be able adequately to deal with hidden problems, even in what they would call an ideal patient. They simply won’t have the experience. I bet they quickly shove such cases off to the public hospital, then wash their hands (so to speak) of the matter.

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Insurance plans do negotiate. The thing is they still extract a lot of money in the process made up by uninsured/under-insured people.

Of course, the federal government was forbidden to negotiate drug prices in creating Medicare D to cover drugs. Really stupid (well, smart for the pharma companies).

ETA:

And higher infant mortality.

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NZ has private insurance, and it’s kind of a scam. It provides what it does in other countries - nominally shorter wait times, fewer plebs coughing on you, plusher rooms, and nicer surroundings for core healthcare, and it covers a few gaps in the public system (vision, dental, pseudo-medicine like acupuncture and chiropractic). AFAIK, the doctors are all working in both systems - 3 or 4 days a week in public, 1 or 2 days a week private.

Frankly, despite it being a fairly small part of the overall healthcare system here, I’d like to see it gone. When everyone must use the same system, everyone is motivated to ensure that the system works. When the wealthy can opt out they’re perversely incented to minimise their input (read: taxes, but also outrage when the system fails) to the public system, and they also hide some of the total healthcare demand, both of which spiral the public system downwards.

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This is something people need to understand. Years ago NYT comparison of many routine medical procedures in NY and Ontario found that they cost 5-10 times as much in the US. What would happen to house prices if we all let your fire insurance company negotiate the purchase price on your behalf?

The greater the value of the thing being insured, the greater the profit of the insurance company. If both sides of a negotiation profit from the price going up, the price is going to go up, up, up.

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Many years ago, when I was in high-school and none of the rest of you were born, Jonathan Miller gave a lecture in my little po-dunk ag college town as part of some book tour.

Brilliant lecture, of course, but he included in it an exhortation to move the United States to a proper system of socialized medicine. My mother, a brit, asked him if he thought that socialized medicine and privatized medicine could co-exist, and he gave a long rambling answer about the NHS and private hospitals in the UK. After the lecture he came up to her and said something like, “Sorry about that, but look around us: most of the audience are physicians in, of course, private practice, and I’m trying to get them on board with the idea of expanding healthcare availability. But the real answer to your question is: no.”

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That one is more complicated than just the way care is delivered in the united states, because it’s directly tied to a different topic that crosses over here:
https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm

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$2 trillion over 10 years ($200 billion/yr) matches up well with 10.6% administrative cost difference on $1.7 trillion a year (180 billion/yr). It’s still just a ~5% decrease in national spending, not some of the big numbers people assume, or that we really need.

People on both sides are getting worked up far more than necessary.

Sadly, all too many people do see it as $0 cost to them. They know it’s being paid for, but don’t realize they are, just in a different way. I’m for single payer because, like you, I agree it will be more efficient. But it’s still wise for people to understand the pluses and minuses. Like a flu shot. It’s not painless, but it’s worthwhile.

You seriously don’t see an easy out for insurers/employers?

Here’s your key term: that duplicates

In general, there’s no law against offering something better than what the law offers. And if libertarians (et al.) want an opportunity to point honestly to a case where government coverage is inferior to that of the private sector, this is the brass ring.

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How many?
You keep saying that “too many” people see it that way, but i’ve never met anyone like that and that attitude certainly has no home here, so i have to ask: what percentage? Is it a serious and documented issue or are you just pulling this out of thin air?

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Approximately zero.

Australian Medicare is primarily funded via general taxation revenue, supplemented by a specific Medicare Levy (2% of income).

However, low income earners (below about $20,000) are exempt from that levy, and Australian income tax also doesn’t kick in until you’re over $18,000.

My income these days is low enough that I pay neither the levy nor any income tax.

If you want to get insanely nitpicky, I do contribute somewhat to general taxation revenue via the 10% GST that everyone here pays when they buy things.

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it’s not too much of a leap to say that under the current system people are literally dying ( while others are losing jobs, or going into bankruptcy, or having simple illnesses unnecessarily compounded. )

public healthcare isn’t just about things being more efficient with single payer ( though it will be. ) it’s about saving lives.

it’s a moral issue first, and an economic issue second.

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